Preventive Care Research Articles

Indicators of the clinical utility of genetic or genomic testing: a scoping review

Abstract Background Genetic or genomic tests are the cornerstones of personalized prevention. Previous reviews primarily focused on theoretical frameworks rather than actual assessments and assessed dimensions rather than specific indicators within these dimensions. Our scoping review aimed to review the dimensions and the specific indicators measured in the published assessment reports of genetic or genomic tests. Methods We selected formal assessments of genetic and genomic test used for prevention through PubMed, Web of Science, Scopus, websites of 20 different organizations, Google, and Google Scholar. Also, through a separate analysis we identified ten comprehensive dimensions of clinical utility through an analysis of 30 theoretical frameworks for genetic and genomic tests. From the included assessments, we extracted all the indicators, clustering them based on the comprehensive dimensions. Results From 3054 unique references and 12000 grey literature search results, we collected 57 assessments, all from high income-countries (in Europe (53%) and North America (47%)). The assessment methods were HTA (42%), EGAPP (25%), ACCE (21%) and other (12%). 951 disease-specific indicators were extracted from the assessments. Analytic validity (60%), clinical validity (79%) clinical efficacy (79%), economic impact (58%) were the most common dimensions (had at least one indicator). However, only 12 assessments (21%) include indicators that compared health outcomes between tested and untested groups. Equity, acceptability, legitimacy, and personal value were evaluated in less than 15% of the documents. Conclusions Our study illustrate that, although dimensions such as equity and acceptability, are significantly emphasized in traditional evaluation frameworks, these are often not considered in the assessments. Additionally, our study has underscored a significant dearth of primary evidence concerning the clinical efficacy of these technologies. Key messages • Our study highlights the prevalence of evaluations lacking indicators for equity, acceptability, and legitimacy dimensions and a lack of direct evidence of clinical efficacy. • The catalog of indicators was openly provided as a resource for researchers and institutions working in evidence-based evaluations of personalized preventive healthcare.

Introducing vaccination services in prison settings: case study from Moldova

Abstract Introducing vaccination services within prison settings presents a multifaceted challenge and opportunity, particularly evident in the case of Moldova. This Eastern European nation grapples with various socio-economic and healthcare disparities, with its prison population often experiencing heightened health vulnerabilities. Amidst such complexities, the implementation of vaccination services emerges as a crucial strategy not only to safeguard the health of incarcerated individuals but also to contribute to broader public health goals. Moldova’s journey in this regard reflects a commitment to advancing preventive healthcare within its correctional facilities. The introduction of vaccination services in prisons necessitated a comprehensive approach, encompassing policy development, infrastructure enhancement, staff training, and community engagement. Infrastructure enhancement was imperative to ensure the provision of vaccination services in a safe, efficient, and dignified manner within prison settings. This involved the establishment of designated vaccination areas equipped with the necessary medical supplies and equipment. Staff training emerged as a cornerstone of the initiative, empowering healthcare professionals working within prisons with the knowledge, skills, and confidence to deliver vaccination services effectively. Training programs encompassed various aspects, including vaccine administration, adverse event management, and communication strategies tailored to the specific needs of incarcerated individuals. Collaboration with people living in prison facilitated the dissemination of accurate information, addressed concerns, and encouraged participation in vaccination programs. During the period 2021-2023 7454 doses of antiCOVID-19, 1298 doses of anti-Flu vaccine, 3083 doses of anti-HBV vaccines were administered.

Essential public health competencies in nursing during the COVID-19 pandemic: A Delphi study

Background & Aim: Nursing practice, characterized by its multifaceted nature, encompasses diverse settings and situations in public health, making it difficult to clearly define the role of nurses in this setting. The study aimed to determine the applicability and relevance of the Regional Core Competency Framework for Public Health in nursing practice during the COVID-19 pandemic. Methods & Materials: Study based on the Delphi methodology, a structured approach to the systematic collectión of expert opinions, to obtain group agreements. Twenty-one nurses working in public health areas during the pandemic participated. Results: The competencies most applied by the nurses were in the domain of health situation analysis and surveillance and risk and damage control. 95% of the nurses were involved in care actions to prevent contagion; 71% analyzed social determinants of health, 100% were involved in the domain of policies, planning, regulation, and control, and 86% in the domain of health promotion. 89% made decisions to favor access to preventive and health care services. 78% valued social participation actions and 76% implemented immediate responses to COVID-19. Conclusion: The main public health competencies used by nursing for dealing with the COVID-19 pandemic are the management of educational processes, health promotion, primary health care, analysis of social determinants, management of health policies, information analysis, and management of immediate responses to challenges generated by COVID-19.

Role of Chikitsa Sutrani to Formulation a Treatment Protocol

The "Role of Chikitsa Sutras in Formulating Treatment Protocols" bridges ancient Ayurvedic wisdom with modern medical practices. Ayurvedic Samhitas, foundational texts, offer therapeutic principles in Chikitsa Sutras. This abstract explores the integration of these guidelines into contemporary protocols, aiming to enhance therapeutic efficacy, optimize patient outcomes, and foster a holistic healthcare approach. MATERIALS AND METHODS: This study employs a multifaceted approach, drawing insights from Ayurvedic Samhitas and contemporary medical literature. The ancient texts, including Charaka Samhita, Sushruta Samhita, and Ashtanga Hridaya, are meticulously reviewed to extract Chikitsa Sutras relevant to various ailments. Additionally, modern medical databases are searched for evidence-based treatment protocols corresponding to these conditions. By juxtaposing Ayurvedic principles with modern therapeutic strategies, this study elucidates synergies and disparities, facilitating the formulation of integrated treatment protocols. RESULTS: The combination of Ayurvedic Chikitsa Sutras with modern treatment paradigms yields profound insights and practical implications. Analysis reveals congruencies in fundamental principles such as holistic patient assessment, personalized treatment approaches, and emphasis on preventive healthcare. Ayurvedic guidelines offer nuanced perspectives on disease aetiology, classification, and management, supplementing modern diagnostic and therapeutic modalities. Integration of Ayurvedic principles into treatment protocols enhances therapeutic efficacy, minimizes adverse effects, and promotes patient-centred care. Moreover, the holistic framework of Ayurveda fosters a comprehensive understanding of health and disease, encouraging lifestyle modifications and preventive measures to augment long-term wellness.

Determinants of oral health among Iranian soldiers: a structural equation modeling study

BackgroundMilitary personnel often face unique challenges in maintaining optimal oral health. This study investigated the oral health status, caries experience, and associated factors among a sample of Iranian soldiers, employing a structural equation modeling (SEM) approach to explore the complex interplay of socioeconomic and behavioral determinants.MethodsA cross-sectional study was conducted among 658 male soldiers aged 18–30 years from three military barracks in Fars province, Iran. Data were collected through a structured instrument and clinical oral examinations. The study employs the DMFT index, which measures caries experience based on decayed, missing, and filled teeth, along with the Simplified Oral Hygiene Index (OHI-S) to assess overall oral health status. Structural equation modeling was employed to analyze the complex relationships between socioeconomic factors, oral health behaviors, and oral health outcomes.ResultsThe mean DMFT score was 3.57 ± 5.91, and the mean OHIS score was 0.56 ± 1.42. SEM analysis revealed that socioeconomic status (SES) indirectly influenced DMFT and oral hygiene scores, mediated by drug use, oral hygiene practices, dietary sugar consumption, and dental visit frequency. Lower toothbrushing frequency was significantly associated with higher DMFT (Estimate = -0.064, p < 0.001) and OHIS scores (Estimate = -0.637, p < 0.001). Drug use (smoking, qalyan, alcohol) was linked to poorer oral health outcomes, while more frequent dental visits were associated with lower DMFT and OHIS scores.ConclusionThis study reveals the complex interplay between socioeconomic conditions, oral health behaviors, and oral health outcomes among Iranian soldiers. The findings highlight the need for targeted interventions to address modifiable risk factors and improve access to preventive dental care within military settings. Future longitudinal studies are warranted to elucidate further the causal pathways between these factors and oral health outcomes in military populations.

Empowering Maternal Choice: Exploring Factors Influencing Early Postpartum Contraceptive Adoption Intention Among Pregnant Women in Northeast Ethiopia

Background: Despite progress in access to family planning services in many sub-Saharan African countries in recent decades, advances in early postpartum contraceptive adoption remain low, and the unmet need for early postpartum contraceptives is high. According to the Ethiopia Demographic and Health Survey report, early postpartum modern contraceptive method uptake is still unacceptably low in Ethiopia. Objectives: This study aimed to determine the magnitude of intention to adopt early postpartum modern contraceptive methods and its associated factors among pregnant women in Dessie and Kombolcha town zones, northeast Ethiopia. Methods: A community-based cross-sectional study was deployed from 15 January–15 February 2023, in the Dessie and Kombolcha zones, northeast Ethiopia, among pregnant women. The study involved 780 pregnant women using the cluster sampling technique. A census was conducted in 20 randomly selected clusters to identify eligible pregnant women. Actual data were collected home-to-home in the community through face-to-face interviews. Data were collected by Open Data Kit (ODK) and exported to STATA 17 for analysis. A multivariable logistic regression analysis was performed, and the goodness of the model was checked by Hosmer–Lemeshow’s test statistic and rock curve. An adjusted odds ratio with a 95% confidence interval and p-value &lt; 0.05 was considered statistically significant. Result: The study revealed that 49.6% of pregnant women lack autonomy and 50% lack knowledge about early postpartum contraception, with participants’ wealth index status ranging from rich (36.6%) to poor (33.2%). The study found that 75.8% of pregnant women intended to adopt early postpartum modern contraceptive methods early after childbirth. After controlling the potential confounders, mother’s age (AOR = 6.2 [2.6–14.6], birth interval (AOR = 2.5 [1.6–3.7]), have paid work (AOR = 1.9 [1.3–2.8]), health facility from home (AOR = 2.6 [1.5–4.4]), last delivery Place (AOR = 2.4 [1.1–5.7]), knowledge on (AOR = 1.5 [1.1–2.1]), and antenatal care follow-up (AOR = 1.9 [1.2–3.3]) were significant associated factors of intention to uptake early postpartum modern contraceptive methods among pregnant women. Conclusions: The study found that 75% of the participants had the intention to adopt contraceptive methods during the early postpartum period. Identified factors influencing this intention were age, birth interval, women’s employment status, area of residence, distance to health facilities, last delivery place, knowledge of early postpartum modern contraception, gravidity, and antenatal care follow-up. These findings highlight the need for targeted interventions to address these factors, framing the intended users and enabling access to early adoption of postpartum contraceptive methods.

Disability, poverty and health-service accessibility in the context of the COVID-19 pandemic: a population-based repeated cross-sectional study in Colombia

ObjectivesIn Colombia, 4.3% of the population 5 years or older lives with a disability. They face higher levels of poverty and social exclusion compared with persons without disabilities. This article...

Integrated Online-to-Offline Model of Care for HIV Prevention and Treatment Among Men Who Have Sex With Men in Malaysia: Protocol for an Intervention Development and a Multiphase Trial.

HIV continues to have a disproportionate impact on specific populations in Malaysia, particularly men who have sex with men (MSM). HIV self-testing (HIVST) is a strategy that has been shown to scale up HIV testing rates. However, it faces shortcomings because of concerns about self-efficacy, result interpretation, and lack of counseling and linkage to care. This underscores the need for an innovative approach that integrates HIVST with timely counseling, expert guidance, and referrals to enhance engagement in relevant HIV prevention or treatment. This study aims to describe the protocol used in developing and testing a web-based platform (ie, CINTAI) providing an HIVST kit and real-time e-counseling to support online-to-offline linkage to HIV care services for MSM in Malaysia. The methods are reported according to the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) 2013 guidelines. In phase I, we will adapt existing HIVST web-based platforms to create a new online-to-offline HIVST and counseling platform called "CINTAI" for Malaysian MSM. In phase II, we will use a type 1 hybrid implementation trial design to determine the feasibility, acceptability, and preliminary efficacy of "CINTAI" compared with treatment as usual among Malaysian MSM, with assessments conducted over 6 months. Multilevel implementation factors will also be collected to guide future adoption and scale-up. We will enroll 78 MSM in the pilot randomized controlled trial. Baseline characteristics will be tested for homogeneity between groups using appropriate statistical tests. A generalized linear mixed model with random subject effects will account for within-subject correlation. Treatment assignment, time, interaction, and confounders will be included. The proportion of MSM tested for HIV over 6 months and other outcomes (pre-exposure prophylaxis for HIV or antiretroviral therapy linkage, HIV risk behaviors, and chemsex harm reduction) will be compared using linear contrasts. We completed phase I of the proposed study in April 2024 and started phase II in May 2024, with 15 participants recruited (7 in the CINTAI and 8 in the treatment-as-usual groups). On the basis of a series of formative works completed during phase I, we developed a fully functional, web-based platform that provides a digital platform for MSM in Malaysia to order HIVST kits for free and to receive HIV counseling, followed by offline linkage to HIV prevention services (if HIV negative) or HIV treatment services (if HIV positive). Despite being at high risk for HIV transmission, MSM in Malaysia have alarmingly low testing and linkage to HIV care services, prompting the need for innovative approaches to support HIV prevention efforts. If found to be feasible and acceptable, CINTAI can be easily adapted for a range of health outcomes and health care delivery services for MSM, including adaptation to other low- and middle-income countries. DERR1-10.2196/60962.

Outcomes of a Community Cat Program Based on Sterilization of Owned, Semi-Owned and Unowned Cats in a Small Rural Town

Free-roaming cats in urban and peri-urban areas and in rural towns pose significant challenges due to their nuisance behaviors, threats to wildlife, and potential disease transmission. Traditional management methods often involve trapping and euthanizing many of these cats, which is not only costly but also distressing for the shelter staff involved, and have failed to reduce numbers of impounded cats or cat-related complaints. Our study aimed to evaluate the effectiveness of a Community Cat Program that provided free sterilization, microchipping, and preventative veterinary care for all owned, semi-owned, and unowned cats in a small rural town with high cat impoundments in Ipswich, Queensland. The program was instigated by the Australian Pet Welfare Foundation in collaboration with the Royal Society for the Prevention of Cruelty to Animals, Queensland and the Animal Welfare League, Queensland, and it was funded by various organizations including Fondation Brigitte Bardot. Data from 2017 to 2023 were analyzed to assess the impact of the program on cat intake and outcomes in local shelters. A total of 308 cats were sterilized, representing 94 cats per 1000 residents over 3.4 years, and in the third year, this was associated with a 60% decrease in cat intake, an 85% reduction in numbers euthanized and 39% fewer cat-related calls to the local council. These findings suggest that high-intensity, targeted sterilization programs significantly decrease shelter intake and euthanasia, and thus alleviate the psychological burden on staff. These programs are a humane and effective alternative to traditional cat management, and benefit animal welfare as well as community wellbeing. This is aligned with a One Welfare approach, which enhances the well-being of animals, humans, and their environments. Legislative changes are required to support these programs to effectively decrease the numbers of free-roaming cats in cities and towns and the issues they cause, while protecting human wellbeing.

74 Reducing unplanned extubations in a level 3 neonatal intensive care unit - the nuts and bolts of UE bundle implementation

Abstract Background Unplanned extubations (UEs) are preventable adverse events that may lead to short term consequences (e.g. cardiopulmonary collapse) and long term sequelae (e.g. acquired airway injury, brain injury) for patients admitted to the Neonatal Intensive Care Unit (NICU). UE prevention care bundles have been demonstrated to reduce UE rates in NICUs; however, implementation of bundle elements is unit dependent. Objectives To describe the work of a UE Prevention Team in a Level 3 NICU with rising UE rates despite implementation of UE prevention bundle per Children’s Hospital Solutions for Patient Safety (SPS). Design/Methods A neonatologist / respiratory therapist pair was assembled in March 2022 to tackle rising UE rates in a 69 bed NICU. Contributing unit stressors included implementation of a new electronic health record, COVID-19 policies, and nursing shortages. Baseline UE rates were &amp;gt;3x the centerline for SPS network NICUs and likely underreported. Steps undertaken include: 1) daily audit to ensure reporting of all UEs, 2) structured post-event team debriefs, 3) unit education campaign to raise awareness of UE prevention and bundle elements, 4) prominent posting of last UE date and reporting on daily team huddle, 5) rapid UE case reviews and apparent cause analysis with reporting of findings unit-wide, 6) optimize endotracheal tube (ETT) securement methods, 6) enforce T2-T3 ETT tip position, 7) standardize x-ray frequencies and reporting, 8) trial of daily rounds ETT safety checklist. Results From rapid case reviews, apparent causes were determined to be incorrect ETT securement device sizing, taping method prone to loss of tape integrity in high humidity, high ETT positions, and inadequate ETT monitoring during high risk activities other than repositioning (invasive/painful procedures, diaper changes). Post-event structured debriefs and unit-wide vigilance increased reporting of UE events to 100%. UE rates fell from a peak of &amp;gt;4 UEs/month, &amp;gt;2.4/100 ventilation days to 1 UE/month, 0.465/100 ventilation days, a 80% reduction.(Figure 1) Most impactful interventions were standard x-ray reporting template in the electronic health record, reinforcing T2-T3 ETT tip positioning, correcting ETT holder sizing, and change in ETT method (Figure 2). Daily rounds checklist was not effective. UE reductions were achieved without changing patient ratios as nurse staffing shortages continued. Conclusion A nimble systems approach is needed to ensure success in implementation of UE prevention care bundles. Simple changes can be made to decrease UEs, guided by rapid case reviews.

Utilizing Citizen Generated Data to enhance Women's Access to Sexual and Reproductive Health Services in Somalia: Insights, Barriers, and Pathways Forward

Purpose: This study was undertaken to capture citizen’s insights on practical steps that individuals, families, communities, and institutions could take to support the improvement of Sexual and Reproductive Health (SRH) services in Somalia. This includes raising awareness of issues affecting women's access to SRH, such as Gender-Based Violence (GBV) and Female Genital Mutilation (FGM). Methodology: This research employed a qualitative research design, utilizing semi-structured radio questions distributed through various channels such as radio promos, mini-dramas, interactive radio shows, and Short Messaging Service (SMS) on mobile phones. To enhance and validate the findings from the radio series, thirty Focus Group Discussions (FGD) involving 270 'hard-to-reach' participants were conducted across all Federal Member States (FMS) of Somalia, excluding Somaliland. Collaborating with 20 radio stations, a total of 4,268 participants from across Somalia were involved in this study. The qualitative data obtained was categorized into themes, and the subsequent information was analyzed using content analysis methodology for qualitative data, as well as descriptive statistics and inferential analysis through statistical package for social science (SPSS) version 25 and excel for quantitative data. The presentation of the data included the use of tables and figures. Findings: This study outlined key challenges in accessing quality SRH services for women in Somalia. Priorities included enhancing healthcare infrastructure and availability of SRH professionals, along with emphasizing health education on reproductive health and family planning. Food insecurity's impact, especially among displaced populations, was noted. GBV and FGM were highlighted, calling for comprehensive survivor care and male involvement in prevention. Collaboration between schools and the private sector was proposed for menstrual hygiene. Men's support for SRH access was deemed crucial. Addressing stigma around SRH access, GBV, and FGM was stressed, urging comprehensive awareness campaigns and improved healthcare provision for survivors. Unique Contribution to Theory, Practice and Policy: Addressing women's SRH in Somalia involves investing in healthcare infrastructure, expanding health education programs, ensuring access to nutritious food, and engaging men as allies in promoting women's SRH rights. Moreover, efforts to combat stigma, GBV, and FGM must be culturally sensitive and inclusive, involving religious and community leaders, and addressing underlying socio-economic factors contributing to these issues.

Beyond the Heart: The Predictive Role of Coronary Artery Calcium Scoring in Non-Cardiovascular Disease Risk Stratification

Coronary artery calcium scoring (CACS), a non-invasive measure of coronary atherosclerosis, has significantly enhanced cardiovascular (CV) risk assessment and stratification in asymptomatic individuals. More recently, a higher score for CAC has been associated with an increased risk of non-CV diseases and all-cause mortality. This review consolidated evidence supporting the role of CAC in assessing non-CV diseases, emphasizing its potential in early diagnosis and prognosis. We observed a strong association between CACS and non-CV diseases, viz., chronic obstructive pulmonary disease, pulmonary embolism, pneumonia, diabetes, chronic kidney disease, osteoporosis, metabolic dysfunction-associated steatotic liver disease, nephrolithiasis, stroke, dementia, malignancies, and several autoimmune diseases. Also, CAC may aid in evaluating the risk of CV conditions developing secondary to the non-CV diseases mentioned earlier. Further evidence from prospective studies, intervention trials, and population-based behavioral studies is needed to establish CAC cutoff values and explore preventative care applications, facilitating their broader integration into healthcare practices.

The interdisciplinary training academy for integrated substance/opioid use disorder prevention and health care: A qualitative look at a new remote field education model.

The opioid syndemic presents a critical need for effective interprofessional training in health care, especially in behavioral health disciplines. Addressing this need, the Interdisciplinary Training Academy for Integrated Substance/Opioid Use Disorder Prevention and Health care (ITA) was developed to provide adaptable educational experiences for emerging behavioral health professionals. This study, reflecting years 2020-2023, explored the experiences and perspectives of ITA fellows regarding interprofessional collaboration and opioid workforce development, focusing on how these elements are integrated. After conducting focus groups, we employed applied thematic analysis to qualitatively analyze the experiences of ITA fellows (11 women and six men; 41% Hispanic/Latino and 59% White; 14 Master of Social Work students and three psychology postdoctoral fellows). This method allowed for a detailed exploration of their perceptions and the nuances of their learning process within the context of opioid workforce development. The findings indicated that fellows' learning processes were adaptive, evolving over time to meet their changing needs. Initially, fellows faced challenges related to role clarity and process understanding. However, they reported significant professional growth as the program progressed, highlighting the effectiveness of the ITA's interprofessional approach in a remote learning setting. The study emphasizes the need for ongoing research to identify and overcome barriers to effective interprofessional collaboration. The results contribute insights into the role of remote field education in preparing future health care professionals to address complex health crises effectively. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Strengthening implementation of integrated care for small and nutritionally at-risk infants under six months and their mothers: Pre-trial feasibility study.

An integrated care pathway to manage small and nutritionally at-risk infants under 6 months (u6m) and their mothers (MAMI Care Pathway) is consistent with 2023 WHO malnutrition guidelines and is being tested in a randomised controlled trial (RCT) in Ethiopia. To optimise trial implementation, we investigated contextual fit with key local stakeholders. We used scenario-based interviews with 17 health workers and four district managers to explore perceived feasibility. Eighteen policymakers were also surveyed to explore policy coherence, demand, acceptability, evidence needs, opportunities and risks. The Bowen feasibility framework and an access to health care framework were adapted and applied. Health workers perceived the MAMI Care Pathway as feasible to implement with support to access services and provide care. The approach is acceptable, given consistency with national policies, local protocols and potential to improve routine care quality. Demand for more comprehensive, preventive and person-centred outpatient care was driven by concerns about unmet, hidden and costly care burden for health services and families. Inpatient care only for severe wasting treatment is inaccessible and unacceptable. Support for routine and expanded components, especially maternal mental health, is needed for successful implementation. Wider contextual factors may affect implementation fidelity and strength. Policymakers cautiously welcomed the approach, which resonates with national commitments, policies and plans but need evidence on how it can work within varied, complex contexts without further system overstretch. A responsive, pragmatic randomised controlled trial will generate the most useful evidence for policymakers. Findings have informed trial preparation and implementation, including a realist evaluation to contextualise outcomes.

The most common neonatal presentations to the pediatric emergency department

Introduction The first 28 days of life are considered the neonatal period, when pediatric health is most vulnerable. While crises can undoubtedly arise during this time, many ED or urgent care visits could be avoided with sufficient preventive hospital care during the newborn period and suitable follow-up with a primary care physician. The use of emergency rooms for non-urgent care could be the cause of rising healthcare costs and ineffective resource use. Purpose This study aimed to determine the presenting features, management, and disposition of neonatal attendance in the emergency department. Methods This was a retrospective observational cross-sectional study of medical records identified via the emergency department of neonatal visits (≤28 days) to King Fahd Hospital of the University (KFHU), Khobar, Saudi Arabia, over 12 months (2021–2022). The Chi-square test was performed to compare various etiologies, with a 5% significance level. Results A total of 649 neonate visited pediatric emergency department with a mean age of 15.5 ± 7.4 days and almost equal distribution of the gender. The most common presentation was upper respiratory tract infection (URTI) (26.8%), followed by physiological jaundice (20.2%), and colic (14%). A total of 205 (31.6%) neonates who visited the ED showed significant laboratory findings. Seventy-nine patients (12.2%) presenting with PED were admitted to the hospital. Conclusion Healthcare systems must devise strategies to address the growing number of non-urgent visits to emergency departments in a more efficient manner, while simultaneously reallocating scarce resources to higher-acuity cases. This emphasizes the necessity of health personnel educating caregivers. It’s also critical that medical professionals understand the common ailments that affect newborns and are skilled at correctly identifying ailments that could indicate a serious pathology.

“But then that's another barrier”: A qualitative study of parent and provider perspectives on rural versus urban disparities in adolescent vaccination

Purpose: Vaccination rates are significantly lower among adolescents living in rural areas compared to those living in urban areas. The objective of this study was to understand the factors contributing to disparities in vaccination between adolescents in rural compared to urban areas.Methods: Semi-structured qualitative interviews were conducted with parents and providers in 16 rural and 4 urban counties of Colorado. Interview questions followed the socioecological model of health and addressed personal, interpersonal, community, and environment/structural barriers and facilitators that impact adolescent vaccination rates. Qualitative content analysis with a directed content analysis approach was used. Urban and rural interviews were compared to identify barriers unique to rural communities.Findings: Reported barriers included lack of vaccine access at primary care, lack of routine preventive care utilization, the need to take off time from work and school, and misinformation about vaccines. Barriers that were unique to rural communities included structural barriers such as lack of evening and weekend appointments, providers not stocking vaccines, short provider tenures, and costs; logistical barriers such as the need for multiple visits to multiple locations and distance and travel time; and beliefs and behaviors such as an overreliance on sports physicals (in lieu of preventive visits) and natural lifestyle cultures.Conclusions: There are unique challenges to adolescent vaccination in rural areas that contribute to fewer adolescents receiving their recommended vaccines. Addressing structural barriers may address this disparity.

Use of Preferred Source of Contraception Among Users of the Pill, Patch, and Ring in the US

Individuals who use contraceptive pills, patches, and rings must frequently interact with the health care system for continued and consistent use. As options for obtaining these methods expand, better understanding contraceptive users' preferences for source of contraception can help facilitate access. To describe use of preferred source of contraception and to understand associations between prior reproductive health care experiences and preference for traditional in-person sources vs alternative sources. This was a cross-sectional nationally representative survey study fielded in the US in 2022 through NORC's population-based AmeriSpeak panel. Eligible panelists were assigned female sex at birth, aged 15 to 44 years, not infecund, and not personally using permanent contraception. Of the screened panelists, 3150 were eligible; 3059 completed the survey (97%). The analysis sample included 595 individuals who currently used a pill, patch, or ring contraceptive. Data were analyzed from January 25, 2023, to August 15, 2024. Primary outcomes were use of any preferred source and use of most preferred source when most recently obtaining contraception. Sources included in-person care, telehealth, pharmacist-prescribed, online service, and over the counter. A binary variable captured whether respondents most preferred traditional, in-person contraceptive care vs an alternative approach. Prior reproductive health care experiences included missing a pill, patch, or ring because they couldn't obtain it on-time and receipt of person-centered contraceptive counseling at most recent contraceptive visit. Sociodemographic characteristics and responses are presented as unweighted numbers with weighted prevalences. In this study, 581 of 595 unweighted respondents (weighted prevalence, 95.9%) of the analytic sample identified as female, 256 unweighted respondents (weighted prevalence, 64.4%) were ages 15 to 29 years, and 448 unweighted respondents (weighted prevalence, 73.8%) had most recently obtained their contraception in-person. Only 197 unweighted respondents (weighted prevalence, 35.6%) selected in-person care as their most preferred source. Additionally, 296 unweighted respondents (weighted prevalence, 49.7%) had most recently obtained their method through any preferred source, and 227 unweighted respondents (weighted prevalence, 39.8%) had obtained it through their most preferred source. In adjusted regression analyses, respondents who previously reported being unable to get their method on time (adjusted odds ratio [aOR], 2.57; 95% CI, 1.36-4.87) had higher odds of preferring an alternative source vs traditional in-person care. Those who recently received person-centered contraceptive counseling (aOR, 0.59; 95% CI, 0.35-0.98) had lower odds of preferring an alternative source. In this national study of individuals who used the pill, patch, and ring, most preferred alternative sources to obtain their contraception, and only half had most recently used a preferred source. These findings suggest that expansion of alternative contraceptive sources can better meet the needs of contraceptive users and support reproductive autonomy.

DẠY HỌC XÁC SUẤT - THỐNG KÊ GẮN VỚI THỰC TIỄN NGHỀ NGHIỆP CHO SINH VIÊN TRƯỜNG ĐẠI HỌC Y DƯỢC THÁI BÌNH

Based on the teaching process in the direction of developing learners’ capability and research results on the Theory of Realistic Mathematics Education, the paper proposes an educational process for using research results in Medicine and Pharmacy to design content for teaching probability and statistics at Thai Binh University of Medicine and Pharmacy, including 5 steps: (1) Finding “realistic situations” from the field of medicine and pharmacy that are suitable for students; (2) Organizing activities for learners to perform learning tasks; (3) Formalizing; (4) Applying; (5) Assessing and Self-assessing. The pedagogical experiment with the content "The law of Total probability" was conducted with the Preventive Healthcare major students at Thai Binh University of Medicine and Pharmacy in the academic year 2023 - 2024. The results showed that the proposed measure improves interest in learning and links probability and statistics knowledge with professional practice.

Activities of Daily Living Disability Transition Patterns in Older Adults with Chronic Diseases: A Four-Year Cohort Study in China.

Older adults with chronic diseases often experience higher rates of Activities of Daily Living (ADL) disability, with research primarily examining the transition between states of ADL disability and non-disability. The current study aims to analyze the patterns and factors of mutual transitions between multiple different ADL disability states in older adults with chronic diseases. This longitudinal study utilized data from the Shanghai Elderly Care Unified Needs Assessment (SECUNA) spanning 2014 to 2017, with 2014 being the baseline. The study included older adults aged 60 years and older with chronic diseases. Using the Markov model, individuals were classified into three states: no ADL disability, mild ADL disability, and severe ADL disability. Transition patterns were analyzed by calculating the frequency, intensity, and probability of transition, and the influencing factors of six transition scenarios were evaluated. Older adults with mild ADL disability were more likely to experience improvement (transition intensity: 0.4731) rather than deterioration (transition intensity: 0.2226) in their ADL disability states. However, those with severe ADL disability faced challenges in improving their states (transition intensities: 0.0068 and 0.1204). Among the six ADL disability transition scenarios, place of residence was associated with four scenarios, age and economic sources were associated with three scenarios, sex was associated with two scenarios, and other factors were associated with one scenario. The transition patterns and factors differ among individuals with varying ADL disability states. It is essential for relevant agencies to implement tailored preventive healthcare strategies to effectively manage the health status of older adults with chronic diseases.

An exploratory study of resettled Rohingya refugees: Healthcare access and preventive cancer screenings.

Research suggests that preventive healthcare needs are high among U.S. refugees from Myanmar; yet no studies have examined healthcare patterns among U.S. Rohingya refugees. We examined participation in preventive cancer screening, healthcare access barriers, and facilitators in a community-based sample of 308 Rohingya refugees in Chicago, Illinois. Descriptives were conducted for the participation rates to preventive cancer screenings, indicated by age and gender. Chi-square tests were used to examine gender differences in barriers and facilitators in healthcare. Participants reported low participation in preventive screenings (e.g. 89.2% never received a Papanicolaou (pap) test). Healthcare access barriers were observed: 82.8% uninsured, 81.2% not knowing where to go for healthcare needs, and 55.1% needed interpretation, with men less likely to have had a doctor's visit in the past year or a regular provider. Findings highlight the urgent need to further develop or tailor interventions to address the healthcare needs for resettled Rohingya refugees.